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An efficient health care system is a priority for all developed countries, and it is an important prerequisite for economic prosperity. Efficiency is measured by the ratio of inputs to outputs of a given system. In the case of health care, inputs include health care expenditure and human and material resources. There are several outputs that can be used to assess efficiency. Among the most important and frequently used are avoidable mortality rates. The consequences of avoidable mortality are understandably very unpleasant for those involved. From a national perspective, avoidable mortality also has serious macroeconomic consequences. The aim of this paper is to assess the efficiency of the health care systems of the member states of the European Union using avoidable mortality rates. Data were taken from the latest available online datasets on avoidable mortality published by Eurostat in 2019. Correlation analysis and multivariate statistical analysis were used. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyse how socio‐economic inequalities in mortality (total and avoidable) evolved in Portugal from the 1990s onwards by looking at differences by gender, age group, poverty and cause of death. Results show that mortality in younger age groups is decreasing faster in the most deprived municipalities. Yet, avoidable deaths do not follow this pattern, particularly with respect to treatable mortality amenable to the health care services. Although total and avoidable mortality are decreasing across all age groups and both genders, decreases in treatable deaths during and after the 2011–14 economic crisis slowed down among the young, with a sharpening of socio‐economic inequalities in avoidable mortality among adults and the elderly. This provides evidence that, in some respects, focusing programmes on those living in poor circumstances has been successful over time. However, the impact of the Great Recession on health care services might have contributed to a significant increase in some treatable causes of death associated with these services. [ABSTRACT FROM AUTHOR]

The consequences of political reunification for health and mortality have the unique character of a 'natural experiment'. This is particularly true for the formerly divided German Baltic Sea region due to its cultural and geographic commonalities. This paper ascertains the changes and differences in premature mortality at ages 0–74 in urban and rural areas of the German states of Mecklenburg–Vorpommern (MV) and Schleswig–Holstein (SH) since reunification and the contribution made by 'avoidable' mortality. Using official cause-of-death data, the effectiveness of health care and health policies was measured based on the concept of avoidable mortality in terms of both amenable and preventable conditions. Methods of decomposition and standardisation were employed in order to erase the compositional effect from the mortality trend. As a result, mortality differences relate primarily to men and the rural areas of the German Baltic Sea region. Whereas the mortality levels in the urban areas of MV and SH have converged, the rural areas of MV still show higher levels of preventable and amenable mortality. The results show that the accessibility and quality of medical care in the thinly populated areas of MV and the effectiveness of inter-sectoral health policies through primary prevention, particularly with regard to men, have room for improvement. [ABSTRACT FROM AUTHOR]

Background Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of ‘avoidable’ mortality.Methods Age-standardized mortality rates for mortality from ‘avoidable’ and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008.Results The paper shows that ‘avoidable’ mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some ‘avoidable’ conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better.Conclusion Declines in overall ‘avoidable’ mortality suggest improvements in the health system’s performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where ‘avoidable’ mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths. [ABSTRACT FROM AUTHOR]

Copyright of Wiener Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The paper published in the January 2015 issue of this journal by Gusmano and colleagues entitled "Shanghai rising: health improvements as measured by avoidable mortality since 2000" has spurred this commentary. We discuss controversial issues surrounding the concept of avoidable mortality in health service research in general and Gusmano's study in particular. The impact of overall social development on mortality may be underappreciated in Gusmano's report; the innovative efforts of healthcare professionals to use cutting-edge technology and evidenceapproved preventive strategies to reduce healthcare cost and improve the life quality of community members may not necessarily come to fruition in death reduction, and might be undervalued, too. More critically, the shape and magnitude of emerging health issues in Shanghai, such as accidents and injuries, pollution-related cancers, may be camouflaged in Gusmano's report. We conclude this commentary by suggesting the most urgent questions to be addressed in the future studies. [ABSTRACT FROM AUTHOR]

Background: Disparities in avoidable mortality have never been evaluated in Italy at the national level. The present study aimed to assess the association between socioeconomic status and avoidable mortality. Methods: The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012–2019 mortality. Outcomes of preventable and of treatable mortality were separately evaluated among people aged 30–74. Education level (elementary school or less, middle school, high school diploma, university degree or more) and residence macro area (North-West, North-East, Center, South-Islands) were the exposures, for which adjusted mortality rate ratios (MRRs) were calculated through multivariate quasi-Poisson regression models, adjusted for age at death. Relative index of inequalities was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. Results: The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65–74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). The greatest inequalities were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Excess risk of preventable and of treatable mortality were observed for the South-Islands. Conclusions: Socioeconomic inequalities in mortality persist in Italy, with an extremely varied response to policies at the regional level, representing a possible missed gain in health and suggesting a reassessment of priorities and definition of health targets. [ABSTRACT FROM AUTHOR]

Background In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries—Argentina, Chile and Uruguay—have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes.Methods We describe NCD programmes and examine mortality trends for the years 1970–2005 among adults aged 15–59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC).Results Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline.Conclusion NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness. [ABSTRACT FROM PUBLISHER]

Introduction: This study provides an economic assessment of the health effects due to exposure to particulate matter PM2.5 in three medium-size cities of northwestern Mexico: Los Mochis, Culiacan and Mazatlán. People in these cities are exposed to high pollutant concentrations that exceed limits suggested in domestic and international guidelines. PM2.5 is an air contaminant negatively associated with people's health when is highly concentrated in the atmosphere; its diameter is below 2.5 µm and causes the air to appear hazy when levels are elevated. To account for the economic impact of air pollution, a Health Impact Assessment (HIA) was used by the means of the European Aphekom Project. We figured the cost-savings of complying with current environmental standards and computed gains in life expectancy, total avoidable premature mortality, preventable cardiovascular disease, and the economic costs of air pollution related to PM2.5. A formal analysis of air pollution epidemiology is not pursued in this paper. Results: The cost of reducing PM2.5 pollution associated with negative health outcomes was based on two different scenarios: Official Mexican Standard (NOM, Spanish acronym) and World Health Organization (WHO) environmental standards. The mean PM2.5 concentrations in 2017 were 22.8, 22.4 and 14.1 µg/m3 for Los Mochis, Mazatlán and Culiacan, respectively. Conclusions: The mean avoidable mortality for all causes associated to PM2.5 exposure in these cities was 638 for the NOM scenario (i.e., with a reduction to 12 µg/m3) compared to 739 for the WHO scenario (reduction to 10 µg/m3). Complying with the WHO guideline of 10 µg/m3 in annual PM2.5 mean would add up to 15 months of life expectancy at age 30, depending on the city. The mean economic cost per year of the PM2.5 effects on human life in these three cities was USD 600 million (NOM scenario) and USD 695 million (WHO scenario). Thus, effective public health and industrial policy interventions to improve air quality are socially advantageous and cost-saving to promote better health. [ABSTRACT FROM AUTHOR]

Objective: To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. Methods: All people aged 25–64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. Results: The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. Conclusion: Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain. [ABSTRACT FROM AUTHOR]

Introduction: Avoidable mortality is an important analysis in public health. This paper presents the analysis of avoidable mortality between 1997-2003 in Santander aiming to guide the health policies in the state. Methods: Descriptive, longitudinal and retrospective analysis of avoidable mortality in Santander 1997-2003 based on the mortality records of the National Department of Statisitcs and taking as reference the clasification of Taucher. Mortality rates for avoidability group, year and provice were calculated and the median rates were plotted in maps for each group. Sex and age specific rates and potentially lost years of life were calculated for 2003 data. Results: In Santander 35% of deaths were avoidable between 1997-2003. The groups with the highest median rates were: accidents, poisoning and violence (F), preventable diseases in infants (E) and preventable disease with early diagnosis or treatment (B). The general ratio man: woman was 2:1 but 4:1 in the group F. Carare-Opón and Soto Norte were the provinces with the highest burden of avoidable mortality. Conclusions: There is an inequity in the way how the avoidable mortality affects the population. The data suggest to review the quality of the promotion and prevention programms and to continue the action against violence in Santander. [ABSTRACT FROM AUTHOR]

Objectives: Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe. Methods: Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001. We partitioned avoidable causes into three categories: those amenable to medical care; those mainly responsive to health policy; and ischaemic heart disease. We used Poisson regression to model the trends. We compared trends with those of nine European countries using published data. Results: Total avoidable death rates fell by 68% in females and 72% in males. The corresponding non-avoidable death rates fell by 35 and 33%. The annual declines in avoidable mortality rates were: 3.47% [95% confidence intervals (CI) 3.44-3.50%] in males and 3.89% (95% CI 3.86-3.91%) in females. For non-avoidable mortality rates, the annual declines were 1.09% (95% CI 1.05-1.13%) and 0.95% (95% CI 0.92-0.98%), respectively. In females, declines in death rates from causes amenable to medical care contributed 54% to the decline in avoidable mortality rates, ischaemic heart disease contributed 45%, and causes responsive to health policy intervention contributed 1%. In males, the corresponding contributions were 32, 57 and 11%. These rates, and the declines between 1980 and 1998, were comparable with selected European countries, with Australia's ranking improving over the period. Conclusion: Trends in avoidable mortality in Australia suggest that the Australian healthcare system has been effective in improving population health. Australia's experience compares favourably with that of Europe. [ABSTRACT FROM AUTHOR]

This paper assesses the changes in avoidable mortality in Lithuania in 1991–1999 compared with 1970–1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age­standardised death rates were calculated. In 1970–1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991–1999 this figure had decreased slightly to 24.6%. At the same time, age­standardised death rates from avoidable causes increased by 8%, from 118.1 per 100,000 in 1970–1990 to 127.9 in 1991–1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991–1999 compared with 1970–1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health. [ABSTRACT FROM AUTHOR]

We analyse the trends in inequality in mortality across poverty groups at different ages over the period 1996–2016 in the Netherlands. In addition, we examine whether these trends are related to unequal changes in avoidable mortality, separated by preventable and treatable causes of death. We find that while inequalities in mortality have decreased at ages up to 65, inequalities increased for the oldest age groups. The decline in inequality at the younger ages can, to a large extent, be explained by a strong decrease of mortality from preventable and cardiovascular causes among the poor. The link between inequality and avoidable mortality at the oldest ages is less straightforward. The increasing inequality at old age might be the result of the inequalities shifting from the young to the older age groups, or of the rich benefiting more from the recent health (care) improvements than the poor. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Public authorities daily deal with the negative consequences of drinking alcohol. Alcohol consumption results in morbidity and mortality, that economically presents lost productivity. Mortality and morbidity related to alcohol differs in regions and in populations. AIMS: This study aims to find out which regions of the Czech Republic are similar in mortality attributable to alcohol. There are many diagnoses specified by the International Classification of Diseases, that relate to alcohol wholly or partially, therefore this study estimates which diagnoses mostly relate to alcoholic death. As there are differences in alcohol attributable fractions, this study provides an insight into the examined issues separately for males and females. METHODS: The mortality attributable to alcohol was calculated based on attributable fractions. To identify similar regions in mortality attributable to alcohol, the cluster analysis was conducted. SAMPLE: The sample consisted of 111 443 deaths (out of which 50.65% deaths attributable to men, 49.35% deaths attributable to women) that occurred in the Czech Republic in 2017. RESULTS: Five clusters were identified as optimal in regard to alcohol mortality not only for men but also for women. The analysis shows differences in mortality related to alcohol between men and women. Diseases of liver and malignant neoplasms of digestive organs were mostly related to alcohol mortality in 2017. CONCLUSIONS: Based on the results it might be conclude that differences in mortality related to alcohol does not reflect the differences in economic development of the Czech regions. [ABSTRACT FROM AUTHOR]

In this article, we carry out the cost-analysis of the total premature mortality and avoidable causes of death for Moldova by applying the human capital approach. The results show that the indirect costs of avoidable mortality represent slightly over 85% of total economic losses due to premature mortality in Moldova. The highest economic losses are due to injuries, cardiovascular diseases, and alcohol and drug-related deaths. For males, the leading cause is represented by injuries, whereas for females the two leading causes include cardiovascular diseases and alcohol and drug-related deaths. The results of this study can be used for a cost-benefit analysis to design economic mitigation strategies aimed at lowering the avoidable mortality in Moldova. [ABSTRACT FROM AUTHOR]

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south‐to‐north patient migration. These findings suggest that—even in a high‐income country with relatively low avoidable mortality like Italy—spending cuts can hurt survival. [ABSTRACT FROM AUTHOR]

Copyright of Quality of Life (1018-0389) / Calitatea Vietii is the property of Romanian Academy Publishing House / Editura Academiei Romane and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Avoidable mortality (AM) is a health indicator used to examine trends in avoidable deaths amenable to public health and medical interventions. AM is more likely amongst marginalized populations. Our objective was to examine trends in AM rates by level of neighborhood marginalization. Decedents under age 75 years in Ontario from 1993 to 2014 (n = 691,453) were assigned to a quintile-level of each Ontario Marginalization (ON-Marg) Index dimension: material deprivation, residential instability, dependency, and ethnic concentration. We calculated ON-Marg Index dimension and quintile specific age- and sex-standardized AM incidence rates. We then calculated annual AM rate ratios between the most (Q5) and least (Q1) marginalized quintiles for each ON-Marg dimension. To describe the inequity gap in AM over time we calculated the absolute difference in the Q5/Q1 rate ratio between 2014 and 1993 for each dimension. AM rates in Ontario were almost halved (48.6%) from 1993 to 2014 (216 vs. 111 per 100,000 population). This decline was greater for treatable AM (75 vs. 36 per 100,000 population) than preventable AM (128 vs. 88 per 100,000 population). The inequity gap in AM Q5/Q1 rate ratios (RR) between 1993 and 2014 widened for all marginalization dimensions: dependency (RR 2.11–2.58), ethnic concentration (RR 0.59–0.48), material deprivation (RR 1.63–2.23), and residential instability (RR 2.01–2.43). To attain further declines in AM, policymakers and governments must address AM due to preventable deaths in neighborhoods highly marginalized by dependency, material deprivation, and residential instability. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.Design: Whole-country, birth cohort study using linked administrative health databases from Scotland.Setting and Participants: Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.Main Outcome Measures: Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2-11 months and at 1-4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.Results: The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2-11 months: HR 68.48, 95% CI (40.57 to 115.60), 1-4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2-11 months: HR 2.42, 95% CI (1.67 to 3.63), 1-4 years: HR 2.53, 95% CI (1.36 to 4.71)).Conclusions: The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures. [ABSTRACT FROM AUTHOR]

The paper published in the January 2015 issue of this journal by Gusmano and colleagues entitled “Shanghai rising: health improvements as measured by avoidable mortality since 2000” has spurred this commentary. We discuss controversial issues surrounding the concept of avoidable mortality in health service research in general and Gusmano’s study in particular. The impact of overall social development on mortality may be underappreciated in Gusmano’s report; the innovative efforts of healthcare professionals to use cutting-edge technology and evidenceapproved preventive strategies to reduce healthcare cost and improve the life quality of community members may not necessarily come to fruition in death reduction, and might be undervalued, too. More critically, the shape and magnitude of emerging health issues in Shanghai, such as accidents and injuries, pollution-related cancers, may be camouflaged in Gusmano’s report. We conclude this commentary by suggesting the most urgent questions to be addressed in the future studies.

The current trends of avoidable mortality, which is an integral indicator of health system performance, were analyzed. The paper discusses the regional heterogeneity of levels and trends in avoidable mortality in the Russian Federation. Also, it contains the analysis of impact of the financial costs of public health on avoidable mortality in regions with different levels of economic development. The last 20-years period was studied, which includes a stage of crisis as well as a social recovery phase. The official data of the State Statistics Committee were analyzed. In Russia, all death cases are registered in accordance to the international classification ICD-10. Special computer program summarizes death cases from preventable causes, and calculates the standardized rates for the population aged from 5 to 64 years. The old European standard of population age structure is used. Estimates of avoidable mortality were made in accordance with the European approach, under which avoidable mortality accumulates deaths of persons aged from 5 to 64 years due to 34 causes and 4 classes of causes. These 38 causes are divided into 3 groups according to three levels of diseases prevention. The level of avoidable mortality in the different regions varies up to 8 times. That is comparable to the difference between Russia and the countries of European Union in 1994. This gap is due to the coexistence of different stages of epidemiological development among the regions in Russia. When death rates increased, it is shown that mortality from causes which are preventable by measures of primary and tertiary prevention increased to a greater extent than mortality from the causes which depend from measures of secondary prevention. Therein, the largest growth of observed mortality was due to low quality of medical care in case of males (group 3), and due to causes which are preventable by measures of primary prevention in case of females (group 1). When mortality was reduced, the rates of change for causes in groups 1 and 3 were approximately the same for both sexes. Avoidable mortality due to late detection of malignant tumors (group 2) has been changed the least. Preventable component defines over 80% of the regional differences in death rates. In 2009, the level of avoidable mortality differed more than fourfold among different regions of the Russia. Similarly, the difference in the level of unavoidable mortality was 1.3-fold and 1.7-fold, for males and females respectively. Proportion of deaths from preventable causes in the total sum of death cases varies from 40% till 75%. Funding for comprehensive programs of public health to a greater extent stimulates the reduction in mortality from preventable causes of the first group. Mortality connected with quality of medical care is more determined by socio-political situation in the country than by regional health care expenses. Based on these results, it is concluded that the action plans to reduce mortality in Russia must have a strong regional specificity, different targets and indicators. Using the proportion of preventable causes, it is possible to separate the regions into groups with different ratios of death determinants, which, therefore, require different approaches to reduce mortality.

Avoidable mortality is an important analysis in publichealth. This paper presents the analysis of avoidable mortality between 1997-2003 in Santander aiming to guide the health policiesin the state. Methods: Descriptive, longitudinal and retrospectiveanalysis of avoidable mortality in Santander 1997-2003 based onthe mortality records of the National Department of Statisitcs andtaking as reference the clasification of Taucher. Mortality ratesfor avoidability group, year and provice were calculated and themedian rates were plotted in maps for each group. Sex and agespecific rates and potencially lost years of life were calculated for2003 data. Results: In Santander 35% of deaths were avoidablebetween 1997-2003. The groups with the highest median rateswere: accidents, poisoning and violence (F), preventable diseases ininfants (E) and preventable disease with early diagnosis or treatment(B). The general ratio man:woman was 2:1 but 4:1 in the group F.Carare-Opón and Soto Norte were the provinces with the highestburden of avoidable mortality. Conclusions: There is an inequityin the way how the avoidable mortality affects the population. Thedata suggest to review the quality of the promotion and preventionprogramms and to continue the action against violence in Santander

The fundamental criticism of the analyses of relations between the allocated sources into healthcare system and general indicators of health status (represented by mortality) form a concept of avoidable mortality. The concept is a result of a reaction of many specialists in this field. The efficient concept of avoidable mortality that consists of treatable and preventable mortality components should provide prominent information that is not directly absorbed in the metrics of general mortality rate traditionally used for measuring the healthcare systems' outputs. Permanent evaluation of the concept is based on confrontation of actual and relevant facts and supported by significant evidence from analytical outputs. This evaluation may help to form an efficient tool for measuring the amenable mortality with system connections as within health care system so in social policy, long-term health care policy, etc. The aim of this article is an analysis and evaluation of avoidable mortality development at conceptual and evaluative level and a specification of advantages and limitations that result from this concept. The analyses' outputs represent a valuable platform for revision of strategic framework of the Slovak healthcare as well as for formation of targeted policies that focus on increase of healthcare system efficiency. [ABSTRACT FROM AUTHOR]

Background: Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation. Methods: We determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15 large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression analysis was used to assess the association between social deprivation and mortality. Results: Mortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the association of mortality with social deprivation tends to be higher in Northern and lower in Southern Europe. Conclusions: There are marked differences in the level of avoidable mortality between neighbourhoods of European cities and the level of avoidable mortality is associated with social deprivation. There is no systematic difference in the magnitude of this association between European cities or regions. Spatial patterns of avoidable mortality across small city areas can point to possible local problems and specific strategies to reduce health inequality which is important for the development of urban areas and the well-being of their inhabitants. [ABSTRACT FROM AUTHOR]

Background: Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran's southern provinces. Methods: All deaths (29916) which happened during 2004-2011 in Bushehr province were assessed. Nolte and McKee's avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and agestandardized death rate. Results: Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion: Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas. [ABSTRACT FROM AUTHOR]

Background: Avoidable mortality (AM), or "unnecessary untimely death," is considered an indicator of health care quality. We investigated trends in the age-standardized mortality rates (ASMRs) and associated standard expected years of life lost (SEYLL) for deaths amenable to medical care or public health measures in Taiwan from 1971-2008, with an emphasis on identifying areas where additional medical or public health investment may help reduce the burden of AM. Methods: Taiwan's ASMRs per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. SEYLL rates per 100,000 were calculated annually from 1971 to 2008 using the same data source. Results: ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% and 7.4% increase among men and women, respectively) and breast cancer (109.8% increase among women). In the same period, SEYLL due to lung cancer increased from 269.2 to 555.7 for men and 249.7 to 342.5 for women. For women, SEYLL due to breast cancer increased from 263.5 in 1971 to 659.3 in 2008. There were gender-specific differences in the reduction (or increase) in AM rates, with women showing larger rates of reduction or smaller rates of increase. Among men, AM fell by 65.9% from 1971-1975 to 2006-2008, and deaths from other causes increased by 15.6%. Among women, AM and deaths from other causes fell by 80.8% and 59.8% respectively. SEYLL decreased, respectively among males and females, from 23,147.3 and 24,081.1 in 1971 to 11,261.8 and 5,929.6 in 2008. Conclusion: From 1971 to 2008, Taiwan experienced a dramatic reduction in most AM and corresponding SEYLL except for lung cancer (for both males and females) and breast cancer (for females). Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be responsible for the increasing AM from lung cancer. If AM in breast cancer continues unabated in the future, greater policy emphasis on the early detection and treatment of breast cancer may also be warranted. [ABSTRACT FROM AUTHOR]

Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production functions using avoidable mortality as outcome measure. Avoidable mortality comprises deaths from certain conditions 'that should not occur in the presence of timely and effective healthcare'. We investigated the relationship between total avoidable mortality and healthcare spending using descriptive analyses and multiple regression models, focussing on within-country variation and growth rates. We aimed to take into account the role of potential confounders and dynamic effects such as time lags. Additionally, we explored a method to estimate macro-level cost-effectiveness. We found an average yearly avoidable mortality decline of 2.6-5.3 % across countries. Simultaneously, healthcare spending rose between 1.9 and 5.9 % per year. Most countries with above-average spending growth demonstrated above-average reductions in avoidable mortality. The regression models showed a significant association between contemporaneous and lagged healthcare spending and avoidable mortality. The time-trend, representing an exogenous shift of the health production function, reduced the impact of healthcare spending. After controlling for this time-trend and other confounders, i.e. demographic and socioeconomic variables, a statistically significant relationship between healthcare spending and avoidable mortality remained. We tentatively conclude that macro-level healthcare spending increases provided value for money, at least for the disease groups, countries and years included in this study. [ABSTRACT FROM AUTHOR]

Objective:To estimate the number of deaths among cancer patients diagnosed in Great Britain that would be avoidable within 5 years of diagnosis if the mean (or highest) survival in Europe for patients diagnosed during 1985–1989, 1990–1994 and 1995–1999 were achieved.Design:Five-year relative survival for cancers in Great Britain compared with that from other countries in the EUROCARE-2, -3 and -4 studies. Calculation of excess deaths (those more than expected from mortality in the general population) that would be avoidable among cancer patients in Britain if relative survival were the same as in Europe.Setting:Great Britain (England, Wales, Scotland) and 13 other European countries.Subjects:2.8 million adults diagnosed in Britain with 1 of 39 cancers during 1985–1989 (followed up to 1994), 1990–1994 (followed up to 1999) and 1995–1999 (followed up to 2003).Main outcome measure:Annual number of avoidable deaths within 5 years of diagnosis. Percentage of the excess (cancer-related) deaths among cancer patients that would be avoidable.Results:Compared with the mean European 5-year relative survival, the largest numbers of avoidable deaths for patients diagnosed during 1985–1989 were for cancers of the breast (about 18% of the excess mortality from this cancer, 7541 deaths), prostate (14%, 4285), colon (9%, 4090), stomach (8%, 3483) and lung (2%, 3548). For 1990–1994, the largest numbers of avoidable deaths were for cancers of the prostate (20%, 7335), breast (15%, 6165), colon (9%, 4376), stomach (9%, 3672), lung (2%, 3735) and kidney (22%, 2644). For 1995–1999, most of the avoidable deaths were for cancers of the prostate (17%, 5758), breast (15%, 5475), lung (3%, 4923), colon (10%, 4295), stomach (9%, 3137) and kidney (21%, 2686).Overall, some 6600–7500 premature deaths would have been avoided each year among cancer patients diagnosed in Britain during 1985–1999 if the mean survival in Europe had been achieved. This represents 6–7% of cancer-related mortality. Compared with the highest European survival, avoidable premature mortality among cancer patients fell from about 12 800 deaths a year (12.2% of cancer-related mortality) to about 11 400 deaths a year (10.6%) over the same period.A large component of the avoidable mortality is due to prostate cancer: excluding this cancer from comparison with the European mean survival reduces the annual number of avoidable deaths by 1000–1500, and the percentage of excess mortality by up to 1%. Compared with the highest survival, the annual number of avoidable deaths would be 1500–2000 fewer, and 1–2% lower as a percentage of excess mortality, but the overall trend in avoidable premature mortality among cancer patients would be similar, falling from 11.4% (1985–1989) to 10.3% (1990–1994) and 9.7% for those diagnosed during 1995–1999.For several cancers, survival in Britain was slightly higher than the mean survival in Europe; this represented some 110–180 premature deaths avoided each year during the period 1985–2003.Conclusions:Avoidable premature mortality among cancer patients diagnosed in Britain during 1985–1999 has represented 6–7% of cancer-related mortality compared with the mean survival in Europe. Compared with the highest levels of survival in Europe, the reduction from 12.2% to 10.6% of cancer-related mortality reflects small but steady progress over the period 1985–2003. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the existence of an excess of avoidable mortality among psychiatric patients in an area with a community-based system of care, to identify predictors of higher risk of avoidable mortality and to provide some possible indication to reduce avoidable mortality in modern psychiatric services. Method: All patients with an ICD-10 psychiatric diagnosis, living in a catchment area of about 75 000 inhabitants, seeking care in 1982–2001 were included ( n = 6956). Mortality and causes of death were ascertained using linkage procedures with other local health databases. Standardized mortality ratios (SMRs) were calculated for each avoidable cause of death. Results: The observed number of deaths for those causes considered avoidable by the European Community was four times greater than the expected ( P < 0.01). SMR was higher for deaths preventable with adequate health promotion policies than for those preventable with appropriate health care. Males, alcohol/drug addicted and young patients have the highest avoidable SMRs. Conclusion: These findings urgently call for the implementation of health promotion and preventive programs targeted to psychiatric patients. Moreover, mental health services should improve the capacity to manage medical health problems of their patients. [ABSTRACT FROM AUTHOR]

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